Understanding "Malignant Hyperthermia," an important condition for those seeking cosmetic surgery.

Because beauty must come with safety! Many people may worry about surgical procedures, especially the "anesthesia" step. Today, Jumroon Clinic will introduce you to a condition that, while very rare, is a top priority for our medical team: Malignant Hyperthermia (MH), or a severe allergic reaction to anesthesia.

What is anesthetic hypersensitivity (MH)?

This condition isn't a typical drug allergy with a rash; it's a genetic disorder triggered by inhaled anesthetics or certain muscle relaxants. This results in a sudden increase in metabolism, muscle stiffness, and a rapid rise in body temperature. If left untreated, it can be life-threatening.

Abnormal responses to anesthesia, medically termed "allergies," are broadly categorized into two main groups based on their mechanisms:

1. Acute drug allergy (Anaphylaxis)

It is an allergy caused by the body's immune system reacting abnormally to anesthetics or surgical drugs (similar to food allergies or pollen allergies)

• Symptoms: Itchy rash, hives, swollen eyes, swollen mouth, bronchospasm causing difficulty breathing, rapid drop in blood pressure.

• Causes: Often caused by neuromuscular blocking agents, antibiotics injected before surgery, or even an allergy to latex gloves.

• Severity: Ranges from mild to anaphylactic shock, requiring immediate antihistamines and vasopressors.

2. Malignant Hyperthermia (MH)

This condition is not an autoimmune allergy, but rather a genetic disorder of the muscles.

• Mechanism: When the body receives anesthetic drugs such as inhalants or certain muscle relaxants, they stimulate muscle cells to release excessive amounts of calcium. This causes muscles throughout the body to tense up and leads to an abnormally high rate of energy expenditure.

• Symptoms: High fever (above 40 degrees Celsius), irregular heartbeat, muscle stiffness, severe acidosis.

• Severity: Life-threatening if the newly emerging drug Dantrolene is not administered to stop the muscle spasms.

Types of allergy	Anaphylaxis	Malignant Hyperthermia (MH)
cause	Drug resistance immune system	Genetic abnormalities in muscle development
Trigger	Injections, antibiotics, latex	Anesthetics, and some muscle relaxants
Prominent symptoms	Rash, swelling, difficulty breathing	High fever, muscle stiffness
Treatment	Antihistamines, adrenaline	Dantrolene, a medication that lowers body temperature

MH (Myasthenia Gravis) is not caused by all types of anesthetics, but is triggered by a specific group of drugs called "triggering agents," as follows:

1. Emerging group of potent volatile inhalation anesthetics.

This group of commonly used anesthetics in modern operating rooms are the primary triggers for MH (Myasthenia Gravis), including:

• Sevoflurane: (Sevofluran) This is the most commonly used in surgery because it provides a quick recovery and has no strong odor.

• Desflurane: (Desfluren)

• Isoflurane: (Isoflurane)

• Halothane: (Halothen) The use of halothane has decreased significantly in Thailand now.

2. Fast-acting depolarizing muscle relaxants.

There is only one main trigger:

• Succinylcholine (Anectine): Often used in emergency endotracheal intubation procedures. This drug binds to muscle receptors and stimulates calcium release. If the patient has a genetic predisposition to MH, this drug will cause sudden, severe muscle spasms.

Warning signs that require attention.

During surgery, the anesthesiologist will closely monitor these symptoms:

• Abnormally high levels of carbon dioxide in the blood.

• Rapid or irregular heartbeat.

• Muscle stiffness (especially around the jaw).

• High fever (rapid rise in fever).

• Dark, cola-like urine.

Who is at risk?

• Individuals with a family history of myasthenia gravis (MH) during surgery.

• Individuals with certain muscle disorders.

• Important Note: If you or any family member have ever experienced adverse reactions during anesthesia, always inform your doctor before surgery.

What types of anesthetics are considered "safe" (non-triggering agents)?

• Intravenous anesthetics (IV Anesthetics): such as Propofol, Etomidate, Ketamine, Benzodiazepines (e.g., Midazolam). This group does not induce MH.

• Local anesthetics: such as Lidocaine and Bupivacaine, used in rhinoplasty or minor surgery, are 100% safe from MH (Manic Hypertension).

• Nitrous oxide (or laughing gas): This also does not stimulate MH.

In summary, from the doctor: Cosmetic surgery isn't something to be afraid of, especially if you choose a reputable clinic with a team of expert doctors and a thorough pre-operative assessment. At Chamroon Clinic, we treat you like family, ensuring you can look your best with confidence and safety.